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Title: Health Equity and Human Rights of the Stateless Hill Tribes in Thailand Researchers: Boonma Soontaraviratana *Narongsak

Noosorn ** Supasit Pannarunothai***Chaiyong Kamrat**** * Loei Provincial Public Health Office. ** Public Health Faculty. Naresuan University. *** Faculty of Medicine. Naresuan University. **** Public Health Faculty. Mahasarakarm University. Abstract: These mixed methodology research was conducted to assess health equity within a human rights framework comparing situations among three groups in Thailand in order to close the gap between these groups. The sample included 789 subjects (Thai, Hill Tribe and Stateless Hill Tribe) from 10 provinces in the north of Thailand. The tool for comparison was the benchmark of fairness for assessing health care reform. Data analysis by ANOVA, Z-score and fulfill by qualitative data. After that present the research result to 17 expertises to suggest for the policy. The research was studies from December 2006 to august 2007. Results revealed a significant differences among three population groups on 7 out of the 9 benchmarks (all at p<.001). The non- significant different benchmarks were efficiency and quality of care (p=.170) and administrative efficiency (p=.227). With regards to Z score analysis, the Thai National citizens (Group 1) had the highest scored (Z = .3293), the hill tribe with Thai national citizenship(group 2) had the average scored (Z=.1275) and the stateless hill tribes(group 3) had the lowest scored (Z=-.3885). Recommendations from experts to bridge the gap included budget allocation to fit with population, health care standards, the laws reforms and decentralization of health service to the local governments.

In conclusion, this research suggested that the Thai government should close the inequity gap by policy mix that affects every population group in Thailand. The establishment of equity with regards to basic health care will promote human rights concerns within Thailand and will serve as an example for the promotion of humanitarian efforts elsewhere. Keywords: Human Rights, Health Equity, Stateless Hill Tribes Supported by Health Insurance System Research Office (HISRO) for Health Systems Research Institute (HSRI)
(Published in Journal of Health Systems Research Vol.3 No.3 Jul.-Sept.2009)

Title: Quality Development of Patient Care Team by Integrated Case Conference in Sung Noen Hospital, Nakhon Ratchasima Province, 2008 Researcher: Nilnetr Veerasombat* et al. *Sung Noen Hospital, Nakhon Ratchasima Province Abstract The purpose of this action research was to solve clinical risks in patient care by professional health care teams. Researchers and participants were heath personnel in Sung Noen community hospital; including the hospital director, physicians, pharmacists, registered nurses, laboratory technicians, radiology technicians, physical therapists, psychologists and ayuravedic doctors. The study was divided into 3 steps; 1) situation analysis: by analyzing clinical risk incident report and former preventive measures 2) implementation: by setting up integrated case conferences i.e. integrated patient care by professional health care team with physicians as the leader who set up a case conference once a month. 3) monitoring and evaluation: by

participants of conference meeting, using questionnaires created by quality development center; evaluating new preventive measures and clinical practice guidelines (CPG) released and enabled to practice. The study was conducted during October 2007 to December 2008, total 18 months. It was found that clinical risk incident report in 2007 was higher in coverage, especially the patient care topic, but repeated incidents were still periodically reported, lack of root cause analysis (RCA) of clinical risk in time and discontinuity of preventive measure practices. Integrated case conference in high level clinical risk topics with physicians as the leader was set up to analyze root cause analysis (RCA) of patient care process. The results were new preventive measures and new clinical practice guidelines that were more practical which promoted quality in patient care team. This study showed that integrated case conference could be effectively conducted in community hospitals. Keywords: quality development, patient care team (PCT), case conference
(Published in Journal of Health Systems Research Vol.3 No.3 Jul.-Sept.2009)

Title: A Study on the Four Dimensions of Health Researcher:Vichai Chokevivat * * Institute for the Development of Human Research Protection Abstract An attempt to include “spiritual health” into WHO definition of health has been made since 1980. It was proposed by member states of WHO in Eastern Mediterranean Region. There were both proponents and opponents of the proposal. Finally the Executive Board of WHO has concluded to propose amendment of the definition of health from

that “the state of complete physical, mental and social well-being and not merely the absence of the disease or infirmity” to “the dynamic state of complete physical, mental, spiritual and social well-being and not merely the absence of disease or infirmity.” However, the proposal did not become the resolution at the World Health Assembly. Thus the definition of health remains the same as stated in the preamble of the Constitution of WHO. In Thailand there was a movement to include the “spiritual health” into the definition of health during the campaign on health system reform in the last decade. Such movement brought about strong controversy rooted from some leading Buddhist organizations which rejected the “spiritual dimension” as a concept influenced by theist paradigm which is opposite to Buddhism. Finally, the consensus has been reached to accept the term “intellectual wellbeing” as the fourth dimension of health. The Health Act B.E. 2007 has then defined health as “the state of human being which is perfect in physical, mental, spiritual and social aspects all of which are holistic in balance” There are still some problems in the new definition of health concerning the exact meaning of mental and spiritual well-being especially when translates into English. This paper proposed not to try to reach consensus in this issue which is very complicate, since the four dimensions have covered all aspects of health. It also proposed Buddhist way of development of the four dimensions of health as an example. The people in different faith can freely develop or extend their means on the basis of their own faith. Key words : Four Dimensions of Health, Spiritual
(Published in Journal of Health Systems Research Vol.3 No.3 Jul.-Sept.2009)

Title: Usage of Herbal Alternatives to Modern Medicine in Lampang Hospital & Community Hospitals in Lampang Province Researchers: Pairat Harinawan*, Wanna Damnoensawat* , Prayuth Srikajang†, Nuchnapang Maneewong*
Lampang Provincial Health Office, Koh Ka District Health Office, Lampang Province

Abstract: This descriptive study was aimed to compare the cost of herbal medicine replacing conventional medicine for treatment of 5 health conditions in 5-year period (2002 – 2006). The study was performed between May 2007 to August 2008. The study samples were 65 health care workers and 260 clients in regional hospitals and 12 community hospitals in Lampang province. The research instruments used consisted of 1) record of the cost for herbal medicine and conventional medicine treatment of 5 health conditions : irritable bowel syndrome, sore throat (non-infectious) constipation, Herpes, and musculoskeletal / joint diseases 2) questionaire for herbal medical order, 3) satisfication form for herbal medicine uses. The data was analyzed by descriptive statistics, compared the cost of herbal medicine replacing conventional medicine by t-test and analyzed clients’s satisfication by Chi–square. The results indicated that the cost of most herbal medicine compared with conventional medicine for 5-health-condition treatment in Lampang province was increased during the studied period. The cost of Turmeric increased from 85,717 Baht in 2002 to 551,272 Baht in 2006, Andrographis increased from 28,152 Baht to 138,681 Baht, Senna alata leaves

increased from 2,797 Baht to 27,104 Baht, Clinacantus nutans leaves increased from 3,490 Baht to 18,101 Baht and Zingiber montanum increased from 14,243 Baht to 298,446 Baht. The comparative cost of herbal medicine during the year 2002 – 2006 was significantly increased (P<.05), except that of Zingiber montanum was not significantly increased. (P=.074) Concerning the health care worker’s perception on herbal medicine order, we found that the samples had experienced in ordering Turmeric 75.4 %, Andrographis 63.1 %, Senna alata leaves 40 %, Clinacantus nutans leaves 41.5% and Zingiber montanum 58.5 %. The main reasons for the decision to order was perceived of drug indication. For the clients’s satisfication for using herbal medicine replacing conventional medicine, we found that the clients had experienced in using Turmeric 68.5 %, Andrographispaniculata 70 %, Candelabra bush 15.4 %, Clinacantus nutans 29.6 % and Zingiber montanum 69.2 %. The satisfication was highly significant (P<.001), the reasons for satisfication was dued to knowing indication and having experiences in using then. From our study results the uses of herbal medicine used: Turmeric, Andrographis, Senna alata leaves, Clinacantus nutans leaves and Zingiber montanum replacing conventional medicine in regional hospital and 12 community hospital of Lampang province from 2002 – 2006 were increased. The increasing rate dued to supportive policy in herbal medicine used in public health center, performing herbal medicine educational meeting, and the reminding strategy of health care workers by placing herbal medicine stickers at the drug payment stations. Key words: herbs, Hospitals in Lampang Province
(Published in Journal of Health Systems Research Vol.3 No.3 Jul.-Sept.2009)

Title: Potentials and Readiness of “tri-parties” on the development of the community health system in 12 subdistricts
Researchers: Supattra Srivanichakorn1, Kasem Vechasuthanon1, Winai Leesmith2, Tassanee Yana1, Onanong Direkbussarakom3, Pattara Sanchaisuriya4, Raviwan Paokanha5, Pongtep Suthirawuth6, Sirinat Nipaporn7, Praksa Bookboon1
1 Institute of Community base Health Care Research & Development, 2 Klong Khlung Hospital - Kamphangphet Province, 3 Northern Health Regional Training Center, 4 NorthEastern Health Systems Research Institute, 5 Faculty of Nursing – Burapha University, 6 Southern Health Systems Research Institute, 7 Naresuan University – Phitsanuloke Province

Abstract This study research is about the situation, potentials and readiness of local government organization, community and networking of health service units in the primary health care level, which works as partnership for local health. This will bring out the improvement of the direction and the role on networking of tri-parties caring of the community health system. The study, thus, emphasizes on the process of both the quantity and quality approaches. The selection of the study area using purposive method, distribution of 4 regions, 2 provinces per region, which are included on both the primary area in the transferring of the mission of the primary health care unit to the local government organization and the experienced areas of on working together total of 12 subdistricts. The method of using qualitative study composed of the questionnaire on the guidelines for interview and focus group discussion which all method has passed and tested by professionals. On the study of potentials and the readiness of the local government organization using the quantitative study from questionnaire by setting up the scale regarding the criteria and use of descriptive analysis. The study resulted on significant situation, capacity, and readiness of the network of health services composed of the policy dimension and the supportive system to health service provider which still have the limit structure especially on the provincial level. While on district and sub-districts level, the clearing structure has worked together more clearly even to some of study area which has the opinion of principle or policy regarding the transfer of mission on health service to local

government organization differently. However, the number of health service provider, the capacity on knowledge, and the experience including the duration of working period on health have a positive impact to the works as partners joining on operational because of individual relationship important but there is still lack of the supporting system for capacity development of health officer working on community and local area to be more effectiveness. However, most of health personnel have understanding on management and use of information in order to report in the level of working unit more than using the information for planning to solve problems in the area level. Capacity and the readiness of community depend on the variety, the role, and strengths of the community leader and the development groups in community including the level of acceptance to health service unit and the local government organization in the area. The reflection on joining and the strengthening of community such as the project that community has started focus on community to management, joining of beneficial, and bring about good governance. However, there might be condition in the development of urban or industrial community which have specific working context. The concrete negotiation on health from community still has limited. There might be in some area which has the management on funding differently in array to the improvement of health but most of them is set up to receive supportive funding more so as to request or negotiation for the benefits of community. Capacity and the readiness of the local government organization regarding the structure found most from the study area will have specific unit regarding the health issue, and it has capacity on the management. The entire study unit has been accepted from the community regarding the local politics. However, the power on getting local revenue and generating income has difference regarding the size of organization. For the expenses on health development of the area it has about 6.64% of total expenses especially from the study area found that the participation on the universal coverage in the area still limited, on both the policy setting in the area in order to bring about the universal coverage for all people in responsibility area, the involvement of providing, purchasing health services, including the role of service monitoring and practice management.

The important suggestion on the part of health service network, community, local from the study compose of 1) support for learning local mechanism of the working together for health 2) promote the improvement of the capacity building of each sector clearly and continuously concerning their capacity and ability. 3) develop mechanism and supporting system such as management system, information system for planning, implementing, and monitoring and evaluation. Moreover, suggestions on the study raised from the meeting among researcher team other key stakeholders to increase the effectiveness of working in order to bring about the community health system are; 1) modifying the goal of the development from transferring of the mission on health to the local government organization in order to promote concept and the process on partnership development among health sector, local government organization, and community 2) advocating policy mechanism and organizational management at the district and provincial for developing public policy on health, concerning social marketing and public communication on health 3) supporting clear and continuous capacity strengthening for local government upon the specific context, patterns could be database development for interesting case studies, organizing appropriate activities for learning process on networking issues of all sectors. Key words: potentials and readiness, local government organization, health service unit, community, community health (Published in Journal of Health Systems Research Vol.3 No.3 Jul.-Sept.2009)